Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial)

Abstract

et al. Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial). Health Technol Assess 2015;19(63). This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). Health Technology Assessment is indexed and abstracted inEditorial contact: nihredit@southampton.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 08/71/01. The contractual start date was in June 2010. The draft report began editorial review in November 2014 and was accepted for publication in April 2015. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily refle...

Impaction and Prediction: Does Ureteral Wall Thickness Affect the Success of Medical Expulsive Therapy in Pediatric Ureteral Stones?

“…Regarding this issue, evaluation of the published data demonstrated well that while the use of alpha blocking agents may facilitate spontaneous passage of ureteric stones in the majority of the cases, the effect of these agents on the stone expulsion time and analgesic need seemed to be variable in different studies [36][37][38][39][40][41] . In other words, data derived from these studies demonstrated that despite the limited data with inconsistent and/or incomplete reporting, treatment of ureteral stones with MET in children results in increased odds of spontaneous ureteral stone passage and a low rate of adverse events [21][22][23] .…”

Comparison of Intravenous Ibuprofen with Intravenous Ketorolac in Renal Colic Pain Management; A Clinical Trial

“…Renal colic is reported in 1 million patients presented to emergency departments in the United States, annually ( 1 ). In England, studies have shown that renal colic has led to 31,000 emergency admissions with 1-day stay and a cost of 19.3 million pounds in 2012 - 2013 ( 2 ). The prevalence of renal colic in the United States and England has been increased by 50% during the past decade.…”

Is tamsulosin effective for the passage of symptomatic ureteral stones

“…[ 4 ] In addition, other types of α-adrenoceptor antagonists, such as nifedipine, have also been suggested to have efficacy in some studies; at the time of the trial design, a trial by Pickard et al showed that the duration of use of agents including nifedipine could increase the rate of spontaneous stone passage and relieve pain. [ 11 ] However, tamsulosin remains the most commonly used pharmaceutical.…”

“…[ 4 ] Nevertheless, these guidelines have been called into question by several recently published high-quality randomized controlled trials (RCTs), and the effectiveness of α-blockers has been questioned for the management of ureteral colic. [ 4 , 7 – 11 ] For instance, a phase III trial that included multiple centers reported no benefit of tamsulosin for patients with distal ureteral calculi in terms of spontaneous stone passage, time to stone expulsion, or analgesic requirements. [ 7 ] In addition, the results of a 28-day course of tamsulosin showed that this treatment did not increase the overall stone passage rate or improve a wide range of secondary outcomes in patients who presented to the emergency department with symptomatic ureteral stones less than 9 mm in diameter.…”